Yale Medicine experts share advice on how to gather during the holidays amid the COVID-19 pandemic.
As the number of COVID-19 cases continues to climb—more rapidly than ever—many people are struggling with how to celebrate Thanksgiving and other upcoming holidays.
Is it safe to gather with a select group of family or friends? Or is it better to cancel everything, stay home in your pajamas, and binge-watch shows instead?
The Centers for Disease Control and Prevention (CDC) says the safest way to celebrate is with members of your household, but also offers precautions to take if you still decide to congregate with others.
Such decisions come down to a calibration of comfort levels—for you and for those you may gather with, Yale Medicine experts say.
Making sound choices is important right now, says Manisha Juthani, MD, a Yale Medicine infectious disease specialist.
“We feel that what we are seeing now, in the number of cases going up, is a post-Halloween spike,” Dr. Juthani says, speaking in mid-November.
“And I’m concerned we might see a post-election spike, as there were a lot of people gathering for that, too. I anticipate the number of cases by Thanksgiving to be worse than it is now.”
Dr. Juthani says she hopes some of the interventions being put in place—including mask mandates in more states and limits on how many people can be at indoor and outdoor gatherings—will curb some of the spread. But she continues to worry.
“The problem is that we have all of these holidays coming during winter, when the cold weather forces people inside. People want to be with their loved ones, but this is where transmission events are happening, more so than in schools,” she says.
“The easy thing to say is to just celebrate with members of your household. But that’s not what Americans look forward to.”
And especially this year, with many families cooped up together with members working or schooling under one roof with limited social interactions, not everyone is eager for yet more intimate together time, Dr. Juthani acknowledges.
Jaimie Meyer, MD, MS, a Yale Medicine infectious disease specialist, agrees that decisions around holiday gatherings are extremely difficult this year.
“There is a spectrum of people’s risk tolerance, and that is true for holidays, too,” she says. “To have zero risk of infection, we would need to cancel all holidays, stay home, and keep completely to ourselves.
For many people, that may not be the healthiest or most satisfying thing to do. But anything we do beyond that takes on some degree of risk, particularly when case levels are increasing in most places in the country, and are expected to go up as we head into the next few months.”
Dr. Meyer points out that there are plenty of stories in the news about people who really wanted to have a family get-together no matter what, and it ended up being a super-spreader event.
“You wouldn’t want to live with that regret for one Thanksgiving meal,” she says.
“However, we all have family members who are getting older, and we miss them. I have a one-year-old nephew I haven’t seen in seven months. You don’t want to let life pass you by.”
So, how can we safely gather?
The answer to that question depends on a number of factors. Drs. Juthani and Meyer share the following tips for helping you decide how to handle the holidays.
Know the ones you’re with
If spending the holidays with just your nuclear family simply won’t work for you, the next step is to figure out who you can gather with safely—and how.
“Maybe you are a family of four and you want to get together with your sibling and their family of four. Everyone is working at home and maybe the kids are going to school in-person.
I am less concerned about schools themselves, but what is happening after school with playdates and such,” Dr. Juthani says.
“If, for two weeks before the holiday, everyone can limit contact with people outside their households and avoid having kids in unsupervised settings such as playdates, sports, sleepovers, and park visits as much as possible, then you are adding a layer of safety.”
Plus, in Connecticut at least, it helps that the governor recently placed a restriction on private gatherings. The rule is that no more than 10 people should gather at one time—indoors or outdoors.
“This makes it easier for people to think about what they even can do, and be more realistic about what a gathering can look like,” Dr. Juthani says.
If possible, gather outside
If you live in an environment where it’s possible to be outside for Thanksgiving, that can be an option, Dr. Meyer says.
For her family, Thanksgiving plans are still up in the air and will depend on current health metrics. But one possibility she is considering is using rented heat lamps and gathering with a brother-in-law’s family of four.
“If weather allows, we will wear masks and eat at separate tables and everyone will have their own food at their table,” she says.
“It’s not that you are completely safe outside or completely unsafe inside, but there is a higher level of risk inside. Either outdoors or indoors, wearing facial coverings and keeping your physical distance lowers your risk of transmitting and acquiring COVID-19.”
If you must be inside, take extra precautions
If an outdoor gathering is not possible and you decide to host the holidays indoors, everyone should wear masks and space out as much as possible, Dr. Juthani says.
“Don’t sit at a long table like you normally would. Maybe you can spread out around a living room or put nuclear families together in certain areas, but all be sort of broadly together,” she says, adding that it helps to have an open floor plan.
Other ideas are opening a window. “Circulating air more broadly and having cross ventilation is best,” says Dr. Juthani. In addition, put out Clorox wipes (if you can find them), bottles of hand-sanitizer, and disposable hand towels in the bathroom. Also, wipe down door knobs, Dr. Meyer suggests.
Protect the most vulnerable
Dr. Meyer stresses that we need to pay special attention to the people in our lives who are at highest risk of severe disease from COVID-19. This includes the elderly and those with underlying medical conditions.
“We want to do everything we can to protect these people, and often, these are the people, including grandparents and older relatives, we want to see the most during the holidays,” she says.
“Unfortunately, there might not be a way to do it safely. For grandparents who really want to see their grandchildren’s faces, you may have to do a Zoom call or stand at the end of the driveway and wave.”
Dr. Juthani agrees that each decision has to be matched to the risk. “One of my neighbors is in her mid-80s and she has grandchildren in their 30s coming in from all over the country to gather and they invited her.
She said, ‘Would I rather have this one Thanksgiving with these grandchildren who I love and miss, or would I rather be around for another Thanksgiving?’” Dr. Juthani says.
Still, some older people are extremely lonely right now; deciding to not see them over the holidays may not feel like the best choice. If that’s the case, try to do a two-week quarantine before Thanksgiving, Dr. Juthani says.
“That way, you can hug them and maybe spend a few days with them,” she says. “But follow the lead of the older people in your life, and talk to them about what they think is best because unless you completely quarantine all members of your family, there is some potential risk.”
Stay close to home
With so many states on travel advisory lists with mandatory quarantine and/or testing requirements on either or both ends of the trip—not to mention any associated infection risks—Dr. Meyer says it’s better to avoid travel.
“If you have to quarantine for two weeks before and after, there’s a month of your life gone and it’s hardly worth it for one night. And does it make sense to put others at risk?” Dr. Meyer says.
Dr. Juthani agrees that this issue is thorny. “I’m of the philosophy that you should avoid travel if you can, but I know there are families who have not seen certain members in over a year. If they live a drivable distance, they might make the trip,” she says.
“The fact is that loneliness, depression, suicide, and all of those struggles are real. Or maybe you have someone in your life with a critical illness, and it may be worth it for that.”
Mind the returning college students
One population likely to be traveling all over the country this Thanksgiving is college students who are returning home, many to stay until after winter break.
“The problem is that the virus will start moving around the country again,” Dr. Juthani notes, adding that she has a daughter returning from college.
“She has done weekly testing, and our plan is to pick her up the weekend before Thanksgiving. We asked her to be extra cautious leading up to that. We’ll get her tested the Thursday before we pick her up.”
Testing is a complicated matter for college students, as certain campuses are testing students before they leave—but not mandating it—and some are not.
Others wonder if they should be testing themselves before gathering with family—regardless of whether they have kids in college.
“Testing as an extra precaution made more sense last summer, because everyone was quarantined and working remotely and kids were home from school. Everything was more bubbled and testing was an extra measure of security,” Dr. Meyer says.
“But now I go to the hospital to see patients. The kids are back at school. There is no way to absolutely lock it down with a quarantine while we are waiting for test results. And there’s the risk of being falsely assured by a false negative.”
Now, Dr. Meyer says she is concerned that everyone will flood test centers, which could lead to a longer turnaround time.
“The easier thing to do is quarantine as long as possible before Thanksgiving,” Dr. Juthani says. “If you are able to get tested in addition, great, but testing is not easy these days. There has been such a press on the system for people who have symptoms or have been exposed. I wouldn’t use it as a security blanket.”
No matter what, be flexible
When it comes to pandemic life, one thing is certain: You need to be flexible and nimble and ready to change your plans at the last minute—or several times, Dr. Meyer says.
“We have to respond to data and what is actually going on in our communities and what the public health restrictions are,” she says.
“For example, last week I may have planned something, but now my state is rolling back to phase 2. Next week, it could be phase 1. You can’t really think about what will happen three months from now.
In terms of holiday parties, you may just have to stay home by yourself. And that’s fine and maybe lower stress. It can mean doing things like buying gifts earlier and shipping them this year.”
And even Thanksgiving dinner can be done over Zoom. Some families are opting to share recipes this year, or when they live close to one another, make and exchange dishes.
Keep perspective
While it may be hard to imagine a “Zoom Thanksgiving,” it’s important to remember life won’t be like this forever, Dr. Meyer says.
“This isn’t an ordinary year. This year, we all need to creatively problem-solve to spend time together and hopefully we will have many more holidays in the future to spend with our loved ones,” she adds.
Dr. Juthani says she is hopeful that the fall and winter holidays of 2021 will be better. “2020 has been a bust in a lot of ways, but we can make decisions that feel appropriate and safe in the short term as we approach this holiday,” she says. “We can do all of this a little longer.”
In the meantime, be kind to yourself during these taxing times—including skipping the cooking.
“How am I supposed to cook a turkey without my mother? She is the one who normally does it,” Dr. Meyer jokes. “I’m considering just ordering dinner. Or this might be the year to stay home and eat straight from the pie with a fork.”
To learn more, visit Yalemedicine.org.
Written by Carrie Macmillan.
